Health equity in economic and trade policies

WTO’s least developed countries submit collective request on services waiver
Bridges Africa, 25 July 2014

In July the WTO’s poorest members, known as the Least Developed Country (LDC) Group, submitted a collective request regarding the preferential treatment they would like to see for their services and service suppliers. The move comes seven months after the global trade body’s ministerial conference in Bali, Indonesia, where members agreed to take steps for bringing this “services waiver” into operation. The LDC services waiver, as it is referred to in trade circles, was initially an outcome of the 2011 WTO Ministerial Conference, held in Geneva, Switzerland. However, in the two years that followed, no preferences had been requested by LDCs or granted to them, prompting WTO members to reconsider ways to use the services waiver. As a result, at the WTO’s subsequent ministerial conference in Bali, Indonesia last December, members agreed to initiate a process aimed at promoting the “expeditious and effective operationalisation” of the LDC services waiver. Over the next six months, WTO members will engage in consultations with the LDC Group in order to respond to the collective request at the high-level meeting. The LDCs have reserved the right to modify the request’s terms ahead of the event.

‘Big Food’: The consumer food environment, health, and the policy response in South Africa
Igumbor EU, Sanders D, Puoane TR, Tsolekile L, Schwarz C et al: PLoS Medicine 9(7), 3 July 2012

In South Africa, as elsewhere in the world, large commercial entities that dominate the food and beverage environment (‘Big Food’) are becoming more widespread and are implicated in unhealthy eating. Interestingly, the authors of this study found that small independent producers (‘Small Food’) remain significant in the food environment in South Africa, and are both linked with, and threatened by, Big Food. Big Food in South Africa involves South African companies, some of which have invested in other (mainly, but not only, African) nations, as well as companies headquartered in North America and Europe. These companies have developed strategies to increase the availability, affordability, and acceptability of their foods in South Africa, as well as having developed a range of ‘health and wellness’ initiatives. Whether these initiatives have had a net positive or net negative impact is not clear. The authors recommend that the South African government act urgently to mitigate the adverse health effects in the food environment in South Africa through education about the health risks of unhealthy diets and regulation of Big Food, including support for healthy foods.

‘Big think’, disjointed incrementalism: Chinese economic success and policy lessons for Africa, or the case for Pan-Africanism
Gros J: African Journal of International Affairs 11(2): 55–87, 2008

Chinese economic success is not the product of free market accidental coincidence, according to this article – rather, it is orchestrated by the State through a mixture of nationalism (‘big think’) and pragmatic decisions (disjointed incrementalism) in agriculture, finance and industry. By following the Chinese example, the author argues for Pan-Africanism, a form of ‘big think’. The main obstacle to development in Africa, he argues, may well be how to align the vested, narrow interests of territorially bound rulers with their citizens, whose languages and cultures tend to transcend the colonially determined national boundaries and who are more likely to support development efforts if they are consonant with existing practices and values. The author argues that Pan-Africanism would allow Africa to take advantage of the economies of scale that accrue with larger markets, give Africa better leverage on its natural resources, allow for easier sharing of resources between rich and poor communities and give the continent greater international clout.

‘Big Think’, disjointed incrementalism: Chinese economic success and policy lessons for Africa, or the case for pan-Africanism
Gros J: African Journal Of International Affairs 11(2): 55–87, 2008

Chinese economic success is not the product of free market accidental coincidence, according to this article – rather, it is orchestrated by the State through a mixture of nationalism (‘big think’) and pragmatic decisions (disjointed incrementalism) in agriculture, finance and industry. By following the Chinese example, the author argues for Pan-Africanism, a form of ‘big think’. The main obstacle to development in Africa, he argues, may well be how to align the vested, narrow interests of territorially bound rulers with their citizens, whose languages and cultures tend to transcend the colonially determined national boundaries and who are more likely to support development efforts if they are consonant with existing practices and values. The author argues that Pan-Africanism would allow Africa to take advantage of the economies of scale that accrue with larger markets, give Africa better leverage on its natural resources, allow for easier sharing of resources between rich and poor communities and give the continent greater international clout.

‘Free trade’ is not what Africa needs, Mr Cameron
Dearden N: The Guardian, Poverty Matters, 19 July 2011

On his trip to South Africa on 18 July 2011, British Prime Minister, David Cameron, talked of the need to go beyond debt cancellation and aid and instead promote free trade with Africa. But ‘free trade’ on inequitable terms has been and will be of no benefit to Africa, the author of this article argues. Africa has much to learn from South Korea, the model to which Cameron refers as a successful example of free-market liberalisation. What Cameron failed to point out, the author notes, is that South Korea used a range of government interventions that are not accepted in free trade practice and are being denied to African governments. The author argues that African prosperity relies on a wholesale rejection of the western free trade model, which means protecting industries, developing alternative and complementary means of trading, control of food production and banking, progressive tax structures, controlled use of savings, and strong regulation to ensure trade and investment really benefits people.

‘Me-too' innovation in pharmaceutical markets
Jena AB, Calfee JE, Mansley EC and Philipson TJ: Forum for Health Economics & Policy 12(1): Article 5, 2009

Critics of 'me-too' innovation often argue that follow-on drugs offer little incremental clinical value over existing pioneer products, while at the same time increasing health care costs. This study examines whether consumers view follow-on and pioneer drugs as close substitutes or distinct clinical therapies. For five major classes of drugs, it found that large reductions in the price of pioneer molecules after patent expiration – which would typically lead to decreased consumption of strong substitutes – have no effect on the trend in demand for follow-on drugs. The findings are likely unaffected by health insurance, competitive pricing of me-toos, marketing, and switching costs.

‘Neoliberal Epidemics’ in Global Context
Schrecker T; Bambra C: Policies for Equitable Access to Health, 2016

Conditionalities attached to loans from the World Bank and IMF were among the key negative influences on health and its social determinants between 1980 and 2000 in many of the more than 75 low- and middle-income countries in which they were applied. Best available evidence suggests that this 'neoliberal epidemics' era is not over. In the future, neoliberalism is likely to reflect the erosion of territorial divisions between core and periphery, or the global North and the global South, in the world economy. The authors write that the success of efforts to fight neoliberal epidemics and reduce health inequalities will depend on blurring boundaries: between the global and local frames of reference, and between public health practice and the politics of health. This last blurring means a return to the wisdom of Rudolf Virchow, to the effect that ‘medicine is a social science, and politics is nothing else but medicine on a large scale’. As Martin McKee and colleagues wrote in a 2012 commentary on the failure of austerity policies, ‘Virchow’s words are as relevant today as they ever were’. Understanding how to translate that insight into political action will require the development of a comparative political science of health inequalities – a critically important project that remains in its infancy.

“Big Food,” the Consumer Food Environment, Health, and the Policy Response in South Africa
Igumbor EU, Sanders D, Puoane TR, Tsolekile L, Schwarz C, Purdy C, Swart R, Durão S and Hawkes C: Plos Med (9) 7: July 2012

The report asserts that in South Africa, as in other jurisdictions, “Big Food” (large commercial entities that dominate the food and beverage environment) is becoming more widespread and is implicated in unhealthy eating. “Small food” remains significant in the food environment in South Africa, and it is both linked with, and threatened by, Big Food. Big Food in South Africa involves South African companies, some of which have invested in other (mainly, but not only, African) nations, as well as companies headquartered in North America and Europe. These companies have developed strategies to increase the availability, affordability, and acceptability of their foods in South Africa; they have also developed a range of “health and wellness” initiatives. Whether these initiatives have had a net positive or net negative impact is not clear. The authors argue that the South African government should act urgently to mitigate the adverse health effects in the food environment in South Africa through education about the health risks of unhealthy diets, regulation of Big Food, and support for healthy foods.

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